|
PR PERI-PX DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 93286
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$57.93 |
| Rate for Payer: Aetna Commercial |
$53.91
|
| Rate for Payer: Aetna Medicare |
$41.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.93
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$40.23
|
| Rate for Payer: BCN Medicare Advantage |
$40.23
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$53.91
|
| Rate for Payer: Cofinity Commercial |
$57.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.24
|
| Rate for Payer: Nomi Health Commercial |
$48.28
|
| Rate for Payer: PACE SWMI |
$40.23
|
| Rate for Payer: PHP Commercial |
$56.32
|
| Rate for Payer: PHP Medicare Advantage |
$40.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health Medicare |
$40.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.23
|
| Rate for Payer: UHC Medicare Advantage |
$40.23
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
PR PERI-PX DEV EVAL & PROG SING/DUAL/MULTI LEAD DFB
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 93287
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$67.46 |
| Rate for Payer: Aetna Commercial |
$62.78
|
| Rate for Payer: Aetna Medicare |
$48.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.78
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$46.85
|
| Rate for Payer: BCN Medicare Advantage |
$46.85
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$67.46
|
| Rate for Payer: Cofinity Commercial |
$62.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.19
|
| Rate for Payer: Nomi Health Commercial |
$56.22
|
| Rate for Payer: PACE SWMI |
$46.85
|
| Rate for Payer: PHP Commercial |
$65.59
|
| Rate for Payer: PHP Medicare Advantage |
$46.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$46.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.85
|
| Rate for Payer: UHC Medicare Advantage |
$46.85
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
PR PERIRECTAL INJ SCLEROSING SOLUTION PROLAPSE
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 45520
|
| Min. Negotiated Rate |
$38.04 |
| Max. Negotiated Rate |
$188.50 |
| Rate for Payer: Aetna Commercial |
$50.97
|
| Rate for Payer: Aetna Medicare |
$39.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.97
|
| Rate for Payer: BCBS Complete |
$116.00
|
| Rate for Payer: BCBS MAPPO |
$38.04
|
| Rate for Payer: BCN Medicare Advantage |
$38.04
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cofinity Commercial |
$54.78
|
| Rate for Payer: Cofinity Commercial |
$50.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.94
|
| Rate for Payer: Nomi Health Commercial |
$45.65
|
| Rate for Payer: PACE SWMI |
$38.04
|
| Rate for Payer: PHP Commercial |
$53.26
|
| Rate for Payer: PHP Medicare Advantage |
$38.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.50
|
| Rate for Payer: Priority Health Medicare |
$38.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.04
|
| Rate for Payer: UHC Medicare Advantage |
$38.04
|
| Rate for Payer: UMR Bronson Commercial |
$133.40
|
|
|
PR PERITONEAL LAVAGE W/WO IMAGING GUIDANCE
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 49084
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$150.78 |
| Rate for Payer: Aetna Commercial |
$140.31
|
| Rate for Payer: Aetna Medicare |
$108.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.31
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$104.71
|
| Rate for Payer: BCN Medicare Advantage |
$104.71
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$150.78
|
| Rate for Payer: Cofinity Commercial |
$140.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.95
|
| Rate for Payer: Nomi Health Commercial |
$125.65
|
| Rate for Payer: PACE SWMI |
$104.71
|
| Rate for Payer: PHP Commercial |
$146.59
|
| Rate for Payer: PHP Medicare Advantage |
$104.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$104.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.71
|
| Rate for Payer: UHC Medicare Advantage |
$104.71
|
| Rate for Payer: UMR Bronson Commercial |
$63.02
|
|
|
PR PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 34713
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Commercial |
$158.62
|
| Rate for Payer: Aetna Medicare |
$123.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.62
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS MAPPO |
$118.37
|
| Rate for Payer: BCN Medicare Advantage |
$118.37
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$170.45
|
| Rate for Payer: Cofinity Commercial |
$158.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.29
|
| Rate for Payer: Nomi Health Commercial |
$142.04
|
| Rate for Payer: PACE SWMI |
$118.37
|
| Rate for Payer: PHP Commercial |
$165.72
|
| Rate for Payer: PHP Medicare Advantage |
$118.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
| Rate for Payer: Priority Health Medicare |
$118.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.37
|
| Rate for Payer: UHC Medicare Advantage |
$118.37
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
PR PERQ ART TRLUML M-THROMBEC &/NFS INTRACRANIAL
|
Professional
|
Both
|
$1,615.00
|
|
|
Service Code
|
HCPCS 61645
|
| Min. Negotiated Rate |
$646.00 |
| Max. Negotiated Rate |
$1,191.73 |
| Rate for Payer: Aetna Commercial |
$1,108.97
|
| Rate for Payer: Aetna Medicare |
$860.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,191.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,108.97
|
| Rate for Payer: BCBS Complete |
$646.00
|
| Rate for Payer: BCBS MAPPO |
$827.59
|
| Rate for Payer: BCN Medicare Advantage |
$827.59
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cash Price |
$1,292.00
|
| Rate for Payer: Cofinity Commercial |
$1,191.73
|
| Rate for Payer: Cofinity Commercial |
$1,108.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$827.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$868.97
|
| Rate for Payer: Nomi Health Commercial |
$993.11
|
| Rate for Payer: PACE SWMI |
$827.59
|
| Rate for Payer: PHP Commercial |
$1,158.63
|
| Rate for Payer: PHP Medicare Advantage |
$827.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,049.75
|
| Rate for Payer: Priority Health Medicare |
$827.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$827.59
|
| Rate for Payer: UHC Medicare Advantage |
$827.59
|
| Rate for Payer: UMR Bronson Commercial |
$742.90
|
|
|
PR PERQ BALO DILA IC VSPSM EA VSL DIFF VASC TER
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 61642
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: UMR Bronson Commercial |
$318.78
|
|
|
PR PERQ BALO DILA IC VSPSM EA VSL SM VASC TER
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
HCPCS 61641
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$225.55 |
| Rate for Payer: Aetna Medicare |
$173.50
|
| Rate for Payer: BCBS Complete |
$138.80
|
| Rate for Payer: Cash Price |
$277.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$225.55
|
| Rate for Payer: UMR Bronson Commercial |
$159.62
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 19285
|
| Min. Negotiated Rate |
$79.33 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Commercial |
$106.30
|
| Rate for Payer: Aetna Medicare |
$82.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.30
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS MAPPO |
$79.33
|
| Rate for Payer: BCN Medicare Advantage |
$79.33
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cofinity Commercial |
$114.24
|
| Rate for Payer: Cofinity Commercial |
$106.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.30
|
| Rate for Payer: Nomi Health Commercial |
$95.20
|
| Rate for Payer: PACE SWMI |
$79.33
|
| Rate for Payer: PHP Commercial |
$111.06
|
| Rate for Payer: PHP Medicare Advantage |
$79.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Medicare |
$79.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.33
|
| Rate for Payer: UHC Medicare Advantage |
$79.33
|
| Rate for Payer: UMR Bronson Commercial |
$103.04
|
|
|
PR PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 19286
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$57.11 |
| Rate for Payer: Aetna Commercial |
$53.14
|
| Rate for Payer: Aetna Medicare |
$41.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.14
|
| Rate for Payer: BCBS Complete |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$39.66
|
| Rate for Payer: BCN Medicare Advantage |
$39.66
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cofinity Commercial |
$57.11
|
| Rate for Payer: Cofinity Commercial |
$53.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.64
|
| Rate for Payer: Nomi Health Commercial |
$47.59
|
| Rate for Payer: PACE SWMI |
$39.66
|
| Rate for Payer: PHP Commercial |
$55.52
|
| Rate for Payer: PHP Medicare Advantage |
$39.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.20
|
| Rate for Payer: Priority Health Medicare |
$39.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.66
|
| Rate for Payer: UHC Medicare Advantage |
$39.66
|
| Rate for Payer: UMR Bronson Commercial |
$31.28
|
|
|
PR PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT
|
Professional
|
Both
|
$1,663.00
|
|
|
Service Code
|
HCPCS 33340
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$1,080.95 |
| Rate for Payer: Aetna Commercial |
$992.73
|
| Rate for Payer: Aetna Medicare |
$770.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$992.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,066.81
|
| Rate for Payer: BCBS Complete |
$665.20
|
| Rate for Payer: BCBS MAPPO |
$740.84
|
| Rate for Payer: BCN Medicare Advantage |
$740.84
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cash Price |
$1,330.40
|
| Rate for Payer: Cofinity Commercial |
$992.73
|
| Rate for Payer: Cofinity Commercial |
$1,066.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$740.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$777.88
|
| Rate for Payer: Nomi Health Commercial |
$889.01
|
| Rate for Payer: PACE SWMI |
$740.84
|
| Rate for Payer: PHP Commercial |
$1,037.18
|
| Rate for Payer: PHP Medicare Advantage |
$740.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,080.95
|
| Rate for Payer: Priority Health Medicare |
$740.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$740.84
|
| Rate for Payer: UHC Medicare Advantage |
$740.84
|
| Rate for Payer: UMR Bronson Commercial |
$764.98
|
|
|
PR PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 19281
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Aetna Commercial |
$124.15
|
| Rate for Payer: Aetna Medicare |
$96.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.15
|
| Rate for Payer: BCBS Complete |
$146.40
|
| Rate for Payer: BCBS MAPPO |
$92.65
|
| Rate for Payer: BCN Medicare Advantage |
$92.65
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$133.42
|
| Rate for Payer: Cofinity Commercial |
$124.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.28
|
| Rate for Payer: Nomi Health Commercial |
$111.18
|
| Rate for Payer: PACE SWMI |
$92.65
|
| Rate for Payer: PHP Commercial |
$129.71
|
| Rate for Payer: PHP Medicare Advantage |
$92.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health Medicare |
$92.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.65
|
| Rate for Payer: UHC Medicare Advantage |
$92.65
|
| Rate for Payer: UMR Bronson Commercial |
$168.36
|
|
|
PR PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 19282
|
| Min. Negotiated Rate |
$46.28 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$62.02
|
| Rate for Payer: Aetna Medicare |
$48.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$66.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.02
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$46.28
|
| Rate for Payer: BCN Medicare Advantage |
$46.28
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$66.64
|
| Rate for Payer: Cofinity Commercial |
$62.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.59
|
| Rate for Payer: Nomi Health Commercial |
$55.54
|
| Rate for Payer: PACE SWMI |
$46.28
|
| Rate for Payer: PHP Commercial |
$64.79
|
| Rate for Payer: PHP Medicare Advantage |
$46.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Medicare |
$46.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.28
|
| Rate for Payer: UHC Medicare Advantage |
$46.28
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
PR PERQ DILATION XST TRC ENDOUROLOGIC PX W/IMG
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
HCPCS 50436
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$205.59 |
| Rate for Payer: Aetna Commercial |
$191.31
|
| Rate for Payer: Aetna Medicare |
$148.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$191.31
|
| Rate for Payer: BCBS Complete |
$122.00
|
| Rate for Payer: BCBS MAPPO |
$142.77
|
| Rate for Payer: BCN Medicare Advantage |
$142.77
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cash Price |
$244.00
|
| Rate for Payer: Cofinity Commercial |
$205.59
|
| Rate for Payer: Cofinity Commercial |
$191.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$142.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$149.91
|
| Rate for Payer: Nomi Health Commercial |
$171.32
|
| Rate for Payer: PACE SWMI |
$142.77
|
| Rate for Payer: PHP Commercial |
$199.88
|
| Rate for Payer: PHP Medicare Advantage |
$142.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.25
|
| Rate for Payer: Priority Health Medicare |
$142.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$142.77
|
| Rate for Payer: UHC Medicare Advantage |
$142.77
|
| Rate for Payer: UMR Bronson Commercial |
$140.30
|
|
|
PR PERQ DILATION XST TRC NEW ACCESS RENAL COLTJ SYS
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
HCPCS 50437
|
| Min. Negotiated Rate |
$238.20 |
| Max. Negotiated Rate |
$553.15 |
| Rate for Payer: Aetna Commercial |
$319.19
|
| Rate for Payer: Aetna Medicare |
$247.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$343.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.19
|
| Rate for Payer: BCBS Complete |
$340.40
|
| Rate for Payer: BCBS MAPPO |
$238.20
|
| Rate for Payer: BCN Medicare Advantage |
$238.20
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cash Price |
$680.80
|
| Rate for Payer: Cofinity Commercial |
$343.01
|
| Rate for Payer: Cofinity Commercial |
$319.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.11
|
| Rate for Payer: Nomi Health Commercial |
$285.84
|
| Rate for Payer: PACE SWMI |
$238.20
|
| Rate for Payer: PHP Commercial |
$333.48
|
| Rate for Payer: PHP Medicare Advantage |
$238.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$553.15
|
| Rate for Payer: Priority Health Medicare |
$238.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.20
|
| Rate for Payer: UHC Medicare Advantage |
$238.20
|
| Rate for Payer: UMR Bronson Commercial |
$391.46
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
HCPCS 32557
|
| Min. Negotiated Rate |
$140.51 |
| Max. Negotiated Rate |
$639.60 |
| Rate for Payer: Aetna Commercial |
$188.28
|
| Rate for Payer: Aetna Medicare |
$146.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.28
|
| Rate for Payer: BCBS Complete |
$393.60
|
| Rate for Payer: BCBS MAPPO |
$140.51
|
| Rate for Payer: BCN Medicare Advantage |
$140.51
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Cash Price |
$787.20
|
| Rate for Payer: Cofinity Commercial |
$202.33
|
| Rate for Payer: Cofinity Commercial |
$188.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.54
|
| Rate for Payer: Nomi Health Commercial |
$168.61
|
| Rate for Payer: PACE SWMI |
$140.51
|
| Rate for Payer: PHP Commercial |
$196.71
|
| Rate for Payer: PHP Medicare Advantage |
$140.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$639.60
|
| Rate for Payer: Priority Health Medicare |
$140.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.51
|
| Rate for Payer: UHC Medicare Advantage |
$140.51
|
| Rate for Payer: UMR Bronson Commercial |
$452.64
|
|
|
PR PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING
|
Professional
|
Both
|
$884.00
|
|
|
Service Code
|
HCPCS 32556
|
| Min. Negotiated Rate |
$119.15 |
| Max. Negotiated Rate |
$574.60 |
| Rate for Payer: Aetna Commercial |
$159.66
|
| Rate for Payer: Aetna Medicare |
$123.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.66
|
| Rate for Payer: BCBS Complete |
$353.60
|
| Rate for Payer: BCBS MAPPO |
$119.15
|
| Rate for Payer: BCN Medicare Advantage |
$119.15
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cash Price |
$707.20
|
| Rate for Payer: Cofinity Commercial |
$171.58
|
| Rate for Payer: Cofinity Commercial |
$159.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.11
|
| Rate for Payer: Nomi Health Commercial |
$142.98
|
| Rate for Payer: PACE SWMI |
$119.15
|
| Rate for Payer: PHP Commercial |
$166.81
|
| Rate for Payer: PHP Medicare Advantage |
$119.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$574.60
|
| Rate for Payer: Priority Health Medicare |
$119.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.15
|
| Rate for Payer: UHC Medicare Advantage |
$119.15
|
| Rate for Payer: UMR Bronson Commercial |
$406.64
|
|
|
PR PERQ NL/PL LITHOTRP COMPLEX >2 CM MLT LOCATIONS
|
Professional
|
Both
|
$2,448.00
|
|
|
Service Code
|
HCPCS 50081
|
| Min. Negotiated Rate |
$979.20 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Aetna Commercial |
$1,436.71
|
| Rate for Payer: Aetna Medicare |
$1,115.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,543.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,436.71
|
| Rate for Payer: BCBS Complete |
$979.20
|
| Rate for Payer: BCBS MAPPO |
$1,072.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,072.17
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cofinity Commercial |
$1,543.92
|
| Rate for Payer: Cofinity Commercial |
$1,436.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,072.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,125.78
|
| Rate for Payer: Nomi Health Commercial |
$1,286.60
|
| Rate for Payer: PACE SWMI |
$1,072.17
|
| Rate for Payer: PHP Commercial |
$1,501.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,072.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,591.20
|
| Rate for Payer: Priority Health Medicare |
$1,072.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,072.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,072.17
|
| Rate for Payer: UMR Bronson Commercial |
$1,126.08
|
|
|
PR PERQ NL/PL LITHOTRP SIMPLE UP TO 2 CM 1 LOCATION
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 50080
|
| Min. Negotiated Rate |
$665.28 |
| Max. Negotiated Rate |
$1,081.60 |
| Rate for Payer: Aetna Commercial |
$891.48
|
| Rate for Payer: Aetna Medicare |
$691.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$958.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$891.48
|
| Rate for Payer: BCBS Complete |
$665.60
|
| Rate for Payer: BCBS MAPPO |
$665.28
|
| Rate for Payer: BCN Medicare Advantage |
$665.28
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cofinity Commercial |
$958.00
|
| Rate for Payer: Cofinity Commercial |
$891.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$665.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$698.54
|
| Rate for Payer: Nomi Health Commercial |
$798.34
|
| Rate for Payer: PACE SWMI |
$665.28
|
| Rate for Payer: PHP Commercial |
$931.39
|
| Rate for Payer: PHP Medicare Advantage |
$665.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,081.60
|
| Rate for Payer: Priority Health Medicare |
$665.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$665.28
|
| Rate for Payer: UHC Medicare Advantage |
$665.28
|
| Rate for Payer: UMR Bronson Commercial |
$765.44
|
|
|
PR PERQ PRCRD DRG 6YR+ W/O CONGENITAL CAR ANOMALY
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
HCPCS 33017
|
| Min. Negotiated Rate |
$203.20 |
| Max. Negotiated Rate |
$339.25 |
| Rate for Payer: Aetna Commercial |
$315.69
|
| Rate for Payer: Aetna Medicare |
$245.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$339.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$315.69
|
| Rate for Payer: BCBS Complete |
$203.20
|
| Rate for Payer: BCBS MAPPO |
$235.59
|
| Rate for Payer: BCN Medicare Advantage |
$235.59
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cash Price |
$406.40
|
| Rate for Payer: Cofinity Commercial |
$339.25
|
| Rate for Payer: Cofinity Commercial |
$315.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.37
|
| Rate for Payer: Nomi Health Commercial |
$282.71
|
| Rate for Payer: PACE SWMI |
$235.59
|
| Rate for Payer: PHP Commercial |
$329.83
|
| Rate for Payer: PHP Medicare Advantage |
$235.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$330.20
|
| Rate for Payer: Priority Health Medicare |
$235.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.59
|
| Rate for Payer: UHC Medicare Advantage |
$235.59
|
| Rate for Payer: UMR Bronson Commercial |
$233.68
|
|
|
PR PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$431.00
|
|
|
Service Code
|
HCPCS 43762
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$280.15 |
| Rate for Payer: Aetna Commercial |
$48.82
|
| Rate for Payer: Aetna Medicare |
$37.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.82
|
| Rate for Payer: BCBS Complete |
$172.40
|
| Rate for Payer: BCBS MAPPO |
$36.43
|
| Rate for Payer: BCN Medicare Advantage |
$36.43
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cash Price |
$344.80
|
| Rate for Payer: Cofinity Commercial |
$52.46
|
| Rate for Payer: Cofinity Commercial |
$48.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.25
|
| Rate for Payer: Nomi Health Commercial |
$43.72
|
| Rate for Payer: PACE SWMI |
$36.43
|
| Rate for Payer: PHP Commercial |
$51.00
|
| Rate for Payer: PHP Medicare Advantage |
$36.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$280.15
|
| Rate for Payer: Priority Health Medicare |
$36.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.43
|
| Rate for Payer: UHC Medicare Advantage |
$36.43
|
| Rate for Payer: UMR Bronson Commercial |
$198.26
|
|
|
PR PERQ REPLACEMENT GTUBE REQ REVJ GSTRST TRC
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
HCPCS 43763
|
| Min. Negotiated Rate |
$83.93 |
| Max. Negotiated Rate |
$417.95 |
| Rate for Payer: Aetna Commercial |
$112.47
|
| Rate for Payer: Aetna Medicare |
$87.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.47
|
| Rate for Payer: BCBS Complete |
$257.20
|
| Rate for Payer: BCBS MAPPO |
$83.93
|
| Rate for Payer: BCN Medicare Advantage |
$83.93
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cash Price |
$514.40
|
| Rate for Payer: Cofinity Commercial |
$120.86
|
| Rate for Payer: Cofinity Commercial |
$112.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.13
|
| Rate for Payer: Nomi Health Commercial |
$100.72
|
| Rate for Payer: PACE SWMI |
$83.93
|
| Rate for Payer: PHP Commercial |
$117.50
|
| Rate for Payer: PHP Medicare Advantage |
$83.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$417.95
|
| Rate for Payer: Priority Health Medicare |
$83.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.93
|
| Rate for Payer: UHC Medicare Advantage |
$83.93
|
| Rate for Payer: UMR Bronson Commercial |
$295.78
|
|
|
PR PERQ SAC AGMNTJ BI W/WO BALO/MCHNL DEV 2/> NDLS
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
HCPCS 0201T
|
| Min. Negotiated Rate |
$977.60 |
| Max. Negotiated Rate |
$1,588.60 |
| Rate for Payer: Aetna Medicare |
$1,222.00
|
| Rate for Payer: BCBS Complete |
$977.60
|
| Rate for Payer: Cash Price |
$1,955.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,588.60
|
| Rate for Payer: UMR Bronson Commercial |
$1,124.24
|
|
|
PR PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL
|
Professional
|
Both
|
$2,317.00
|
|
|
Service Code
|
HCPCS 0200T
|
| Min. Negotiated Rate |
$926.80 |
| Max. Negotiated Rate |
$1,506.05 |
| Rate for Payer: Aetna Medicare |
$1,158.50
|
| Rate for Payer: BCBS Complete |
$926.80
|
| Rate for Payer: Cash Price |
$1,853.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,506.05
|
| Rate for Payer: UMR Bronson Commercial |
$1,065.82
|
|
|
PR PERQ SKELETAL FIXATION PST PELVIC BONE FX&/DIS
|
Professional
|
Both
|
$3,172.00
|
|
|
Service Code
|
HCPCS 27216
|
| Min. Negotiated Rate |
$1,268.80 |
| Max. Negotiated Rate |
$2,061.80 |
| Rate for Payer: Aetna Medicare |
$1,586.00
|
| Rate for Payer: BCBS Complete |
$1,268.80
|
| Rate for Payer: Cash Price |
$2,537.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,061.80
|
| Rate for Payer: UMR Bronson Commercial |
$1,459.12
|
|
